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Where’s the Beef in EHR Savings?

A recent NY Times article, In Second Look, Few Savings from Digital Health Records, focuses on a new RAND report.  It asks that age old question: Where’s the beef? In other words, when will we see financial benefits from our investment in health information technology?

I think we’re all impatient.  It’s not just the economic gains we want; it’s the personal gains we look forward to as patients. But the real savings won’t come from individual healthcare organizations embracing healthcare technology – that’s a “get on board” cost before the organizations are connected to one another.

True, electronic health records (EHRs) cut down on costs for things like transcription and medical records storage, and they can also help make sure that providers are appropriately billing. (Where do you find any other profession that doesn’t bill the full price for services because someone lost a slip of paper?)

Having an EHR is just Step One. It’s an important step but not the end of the journey. Using an EHR is about collecting the patient’s data and making it available to every appropriate person in the organization more easily and more quickly. But it’s just one step towards the goal of a connected community of health.

Let’s talk about data fluidity

In healthcare, we want data that travels.  The question, though, is how far can your data travel, and with what sort of friction? If all you have is a stand-alone EHR, then all it can do is travel within the one organization. If you have a patient portal, then the data can travel to the portal. But that’s it. 

And when data does travel, there’s always a measurement of how much effort it takes – what is the data friction?  Think about a free market economy – how freely can the data move around? And at what cost?

Isn’t that sort of like a pre-Internet computer? When computers are not connected, the cost of moving data is exactly equal to the cost of the original data acquisition. The friction is infinite and the data is paralyzed.  The same is true in healthcare – we have high data friction and in most cases, paralyzed data.

So that brings us to the crucial Step Two: The real savings in EHRs come when they are connected to one another and facilitating data exchange between providers – a situation in which most providers do not currently find themselves.

Once we reduce the data friction and increase the data fluidity so that data can be available to the provider when important decisions are being made, that’s when it gets remarkably cheaper – both in financial and personal terms.

What gets better, easier and faster when data is fluid?

This study got me thinking about where we’re at, and where we’re headed with healthcare data. There are clear benefits when data is fluid, such as:

  • You never have to fill out “the clipboard form” more than once
  • Lab result trends can be recognized sooner when historical data is aggregated from multiple sources
  • Decisions can be made sooner and with greater confidence

I think the last one is the key. If your cholesterol is border line now, the relevant question is, what did it used to be?  It’s a very important question. If it used to be border line and still is, meds, diet change or exercise may not be required because you are relatively stable. If it used to be normal, however, and is 20 points higher only six months later, you would look to a different plan of attack.

And this is true across the board – early detection is better than not, and informed care is better than care made without all the relevant information. But to get there, the data needs to flow freely.

So what does the Health IT community have to do?

  1. There have been tremendous gains in usability within the EHR industry in the last couple of years, but that’s a job that can never be “finished.” New technology like iPads or Windows 8 comes out all the time.  It is incumbent upon us to leverage those technologies to lower the initial point of data friction – the initial data acquisition cost. We have to do it, then re-do it, then re-invent it again.
  2. We have to connect all of our systems together. Toyotas & Chevys & Mercedes all share the same highways. We need healthcare highways in a desperate way in our country, and then health IT vendors need to share them.

And what can you do?

  1. Don’t go to a doc that’s on paper. As long as you never move, never go on vacation, and never have to see a specialist, that’s fine. But if you do (who doesn’t?), you will get to fill out the form on the clipboard over and over again as long as you are seeing a paper-based physician.
  2. Continue to be impatient with your Health IT vendor. We need to be connecting everything together to lower data friction and increase data fluidity.

Step One is like the stand alone computer. Definitely some benefits, but limited in lots of ways.

Step Two is like the Internet-enabled computer. You get to do everything you already did, plus you can access data from all over planet Earth.

And Step Three?  That’s the journey we are on together.

Editor’s Note: For another response to the RAND report, visit Leigh Burchell’s blog post:  In EHR Adoption, Patience is a Virtue.

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